Clinical presentation:

Among these main symptoms nasal itching and sneezing are features of allergic rhinitis and hence are not seen in intrinsic rhinitis. All the other symptoms are manifested in intrinsic rhinitis.

Seebohm identified two groups of patients amongst those suffering from perenial rhinitis. One group had eosinophils in their nasal secretions while the other did not have any eosinophils in their nasal secretions. Accordingly he classified intrinsic / perenial rhinitis into eosinophilic and non eosinophilic types.

Eosinophilic group: This group is characterised by marked nasal congestion, profuse rhinorrhoea, hyposmia, inferior turbinate hypertrophy and mucoid nasal secretion. Nasal polyposis frequently occurred in this group of patients.

Non eosinophilic group: In these patients nasal obstruction is very mild, rhinorrhoea is very severe. They donot have significant mucosal swelling. Inferior turbinate hypertrophy is not significant. Tendency of nasal polyp formation is rare in this group.

Symptom

Eosinophilic

Non-eosinophilic

Obstruction

Moderate / severe

mild

Rhinorrhoea

Mild / moderate

severe

Sneezing/pruritis

Minimal

Minimal

Hyposmia

Usual

Rare

Mucosal swelling

Marked

Mild

Inf turbinate enlargement

Marked

Mild

Polyps

Common

Never

Sinus mucosal thickening

Common

Rare

Table showing the differences between eosninophilic and non eosinophilic types of intrinsic rhinitis

The following transmitters are secreted by sympathetic nerve endings: adrenaline, noradrenaline, neuropeptide Y.

The nasal resistance to air flow is controlled by sympathetic system, whereas the nasal glands are innervated by parasympathetic nerves. Increased parasympathetic outflow causes glandular hypersecretion. Vaso active intestinal polypeptide has been known to cause this effect. The vasodilatation caused due to the effects of vaso active intestinal polypeptide is resistant to the effects of atropine.

Management:

Majority of patients with intrinsic rhinitis benefit from medical management. Only a few require surgical management.

Medical management of intrinsic rhinitis:

Eosinophilic type:

Steroids - Topical e.g. fluticasone, budesonide. A short course of systemic steriods can be administered.